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European Respiratory Journal 02/20/2020 08:21
Introduction. Pathophysiology changes associated with pleural effusion, its drainage, and factors governing symptom response are poorly understood. Our objective was to determine the:. i. Effect of pleural effusion (and its drainage) on the cardiorespiratory, functional, and diaphragmatic parameters;. ii. Proportion and characteristics of patients with breathlessness relief post-drainage. Methods. Prospectively-enrolled patients with symptomatic pleural effusions were assessed pre- and at 24–36 h post-therapeutic drainage. Main results. 145 participants completed pre- and post-tests; 93% had effusions ≥25% of hemithorax. The median volume drained was 1.68 L. Breathlessness scores improved post-drainage [VAS score by 28.0 mm (mean, sd=24); Dyspne.
European Respiratory Journal 02/20/2020 08:21
The treatment for obstructive sleep apnea (OSA) with continuous positive airway pressure (CPAP) or mandibular advancement devices (MAD) is associated with blood pressure (BP) reduction however, the overall effect is modest. The aim of this systematic review and meta-analysis of RCTs comparing the effect of such treatments on BP was to identify subgroups of patients who respond best to treatment. The article search was performed in three different databases with specific search terms and selection criteria. From 2289 articles, we included 68 RCTs that compared CPAP or MAD with either passive or active treatment. When all the studies are pooled together, CPAP and MAD are associated with an average BP reduction of –2.09 (–2.78, –1.40) mmHg [me.
European Respiratory Journal 02/20/2020 08:21
Ventilatory settings are critical in mechanically ventilated extremely preterm newborn infants due to the risk of ventilation induced lung injury (VILI) and subsequent development of bronchopulmonary dysplasia (BPD) [1]. The positive end-expiratory pressure (PEEP) settings usually rely on blood gases, oxygen requirement, lung auscultation, evaluation of chest radiograph, and assessment of pressure-volume curves provided by the ventilators. Studies of optimal PEEP settings in the surfactant treated preterm infant in need of mechanical ventilation are limited and evidence based clinical guidelines are sparse [2, 3].
European Respiratory Journal 02/20/2020 08:21
Introduction. Inhaled corticosteroids (ICS) achieve disease control in the majority of asthmatics, although adherence to prescribed ICS is often poor. Patients with severe eosinophilic asthma (SEA) may require treatment with oral corticosteroids (OCS) and/or biologic agents such as mepolizumab. It is unknown if ICS adherence changes on, or alters clinical response to, biologic therapy. Methods. We examined ICS adherence and clinical outcomes in OCS-dependent SEA patients who completed 1 year of mepolizumab therapy. The ICS Medicines Possession Ratio was calculated (MPR; the number of doses of ICS issued on prescription/expected number) for the year before and the year after biologic initiation. Good adherence was defined as MPR>0.75, intermed.
European Respiratory Journal 02/20/2020 08:21
Introduction. TBX4 mutation cause small patella syndrome (SPS) and/or pulmonary arterial hypertension (PAH). The characteristics and outcomes of PAH associated with TBX4 mutations are largely unknown. Methods. We report the clinical, functional, radiologic, histologic and haemodynamic characteristics and outcomes of heritable PAH patients carrying a TBX4 mutation from the French PH Network. Results. Twenty patients were identified in 17 families. They were characterised by a median age at diagnosis of 29 (0–76) year-old and a female to male ratio of 3. Most of the patients were in NYHA functional class III or IV (70%) with a severe hemodynamic impairment (median pulmonary vascular resistance of 13.6 [6.2–41.8] Wood Units). Skeletal signs of SP.
European Respiratory Journal 02/20/2020 08:21
Lymphangioleiomyomatosis (LAM) is a multisystem disease associated with progressive pulmonary disease that affects almost exclusively women. LAM is characterised pathologically by proliferation of abnormal smooth muscle-like cells carrying mutations in predominantly the Tuberous Sclerosis Complex (TSC) gene TSC2 , and rarely in TSC1 [1]. LAM can occur sporadically or in association with TSC. Mutations in the TSC genes lead to activation of the mammalian/mechanistic target of rapamycin complex 1 (mTORC1) [2].
European Respiratory Journal 02/20/2020 08:21
Antibody-mediated rejection (AMR) after lung transplantation (LTx) is associated with poor prognosis [1]. Recent ISHLT recommendation propose a standardised classification of lung AMR [2]. Based on the number of features present, these classification describe three different degree of certainty for the AMR diagnosis. However in the absence of a true gold standard, the management of potential AMR rely on a quite high degree of uncertainty.
European Respiratory Journal 02/20/2020 03:41
Stratification of asthmatic patients based on relevant biomarkers enables the prediction of responsiveness against immune-targeted therapies in patients with asthma. Individualised therapy in patients with eosinophilic asthma has yielded improved clinical outcomes; similar approaches in patients with neutrophilic asthma have yet to be developed. We determined whether colony-stimulating factors (CSFs) in the airway reflect the inflammatory phenotypes of asthma and contribute to disease progression of neutrophilic asthma. We analysed three different mouse models of asthma and assessed cytokine profiles in sputum from human patients with asthma stratified according to inflammatory phenotype. In addition, we evaluated the therapeutic efficacy o.
European Respiratory Journal 02/20/2020 03:41
Rationale. There is growing evidence that air pollution may contribute to the development of childhood asthma and other allergic diseases. In this follow-up of the Toronto Child Health Evaluation Questionnaire (T-CHEQ) study, we examined associations between early life exposures to air pollution and incidence of asthma, allergic rhinitis and eczema from birth through adolescence. Methods. 1286 T-CHEQ participants were followed from birth until outcome (March 31, 2016) or loss to follow-up, with a mean of 17 years of follow-up. Concentrations of nitrogen dioxide (NO 2 ), ozone (O 3 ) and particulate matter with a 50% cut-off aerodynamic diameter of 2.5 µm (PM 2.5 ) from January 1, 1999 to December 31, 2012 were assigned to participants based o.
European Respiratory Journal 02/20/2020 03:41
In patients with fibrotic interstitial lung disease (ILD), hypoxaemia on exertion is frequent, and contributes to exercise intolerance, exertional dyspnoea and reduced quality of life [1–3]. Clinically significant exertional hypoxaemia is typically defined as a drop in transcutaneous arterial oxygen saturation ( S pO 2 ) to ≤88% on a 6-min walk test (6MWT) [4], and is associated with reduced survival in ILD patients [5].
European Respiratory Journal 02/20/2020 03:41
Asthma and chronic obstructive pulmonary disease (COPD) cause significant morbidity and mortality worldwide. In the context of disease pathogenesis, both asthma and COPD involve chronic inflammation of the lung and are characterised by the abnormal release of inflammatory cytokines, dysregulated immune cell activity and remodelling of the airways. To date, current treatments still only manage symptoms and do not reverse the primary disease processes. In recent work, interleukin (IL)-1α and IL-1β have been suggested to play important roles in both asthma and COPD. In this review, we summarise overwhelming pre-clinical evidence for dysregulated signalling of IL-1α and IL-1β contributing to disease pathogenesis and discuss the paradox of IL-1
European Respiratory Journal 02/20/2020 03:41
The investigation by Tan et al . [1] addresses an important question regarding the impact of marijuana smoking in middle-aged and older individuals and the relative risk for developing COPD and an accelerated rate of decline in lung function. The importance of this question is underscored by the spreading legalisation of marijuana and the likely impact on its use in both older and younger persons. The authors approached this question using data from a Canadian cross-sectional population-based prevalence study of COPD carried out in subjects ≥40 years (the COLD cohort) and a selected subsample who were followed for up to 4 years and either had physiological evidence of COPD (forced expiratory volume in 1 s (FEV 1 ) to forced vital capacity r.
European Respiratory Journal 02/20/2020 03:41
Dietary antioxidant intake has been hypothesised to influence lung function. The association between total antioxidant capacity (TAC) of the diet at age 8 years and lung function development up to 16 years in 2307 participants from the Swedish population-based birth cohort BAMSE (Children, Allergy, Milieu, Stockholm, Epidemiology) was investigated. Information on TAC was obtained from a food frequency questionnaire at 8 years. Lung function was measured by spirometry at 8 and 16 years, impulse oscillometry (IOS) and exhaled nitric oxide fraction ( F eNO ) at 16 years. Low lung function was defined as forced expiratory volume in 1 s (FEV 1 ) z-score below the 25th percentile. Longitudinal associations between TAC and lung function were analy.
European Respiratory Journal 02/20/2020 03:41
Background. Inhaled corticosteroids (ICS) are suggested for potential chemoprevention of lung cancer. Several observational studies in patients with chronic obstructive pulmonary disease (COPD) reported inconsistent results, either significant reductions in lung cancer incidence with ICS use or no effect. We assessed this association, using an approach that avoided biases affecting some of the studies. Methods. A cohort of patients with COPD, new users of long-acting bronchodilators over 2000–2014, was formed using the Quebec healthcare databases, and followed until 2015 for a first diagnosis of lung cancer. A 1-year delay after cohort entry was used to avoid protopathic bias and a 1-year latency period was included after the initiation of IC.
European Respiratory Journal 02/20/2020 03:41
In recent years, the e-cigarette market across European countries has grown extensively [1, 2], as 15% of Europeans report having tried e-cigarettes, representing a 7.0% increase since 2012 [3]. E-cigarettes are regulated across the 28 European Union (EU) member states [4] under Article 20 of the Tobacco Products Directive (TPD), a legislative document which aims to regulate the internal European market and to harmonise the safety and quality of e-cigarette products through design specifications, including, but not limited to the volume of the refill container, nicotine content and the existence of child-resistant refill containers, among other parameters. In order for e-cigarette refill vials to be placed onto the market under the TPD, e-c.
European Respiratory Journal 02/14/2020 06:10
Aim. Acute exacerbation of idiopathic pulmonary fibrosis (AE-IPF) is an often deadly complication of IPF. No focused international guidelines for the management of AE-IPF exist. The aim of this international survey was to assess the global variability in prevention, diagnostic and treatment strategies for AE-IPF. Material and methods. Pulmonologists with ILD expertise were invited to participate in a survey designed by an international expert panel. Results. 509 pulmonologists from 66 countries responded. Significant geographical variability in approaches to manage AE-IPF was found. Common preventive measures included antifibrotic drugs and vaccination. Diagnostic differences were most pronounced regarding use of KL-6 and viral testing, while
European Respiratory Journal 02/14/2020 06:10
Introduction. Inhaled corticosteroids (ICS) achieve disease control in the majority of asthmatics, although adherence to prescribed ICS is often poor. Patients with severe eosinophilic asthma (SEA) may require treatment with oral corticosteroids (OCS) and/or biologic agents such as mepolizumab. It is unknown if ICS adherence changes on, or alters clinical response to, biologic therapy. Methods. We examined ICS adherence and clinical outcomes in OCS-dependent SEA patients who completed 1 year of mepolizumab therapy. The ICS Medicines Possession Ratio was calculated (MPR; the number of doses of ICS issued on prescription/expected number) for the year before and the year after biologic initiation. Good adherence was defined as MPR>0.75, intermed.
European Respiratory Journal 02/14/2020 06:10
Obstructive pulmonary disease in patients with alpha-1 antitrypsin (AAT) deficiency (AATD) occurs earlier in life compared to patients without AATD. To understand this further, the aim of this study was to investigate whether AATD presents with altered neutrophil characteristics, due to the specific lack of plasma AAT, compared to non-AATD COPD. This study focused on the neutrophil plasma membrane, and by use of label-free tandem mass spectrometry, the proteome of the neutrophil membrane was compared in FEV 1 -matched AATD, non-AATD COPD and in AATD patients receiving weekly AAT augmentation therapy (n=6 patients per cohort). Altered protein expression in AATD was confirmed by western blot, ELISA and fluorescence resonance energy transfer a.
European Respiratory Journal 02/14/2020 06:10
Introduction. The ex vivo lung perfusion (EVLP) technique has been developed to assess the function of marginal donor lungs which has significantly increased donor lung utilisation. EVLP has also been explored as a platform for donor lung repair through injury specific treatments such as antibiotics or fibrinolytics. We hypothesised that actively expressed pathways shared between transplantation and EVLP may reveal common mechanisms of injury and potential therapeutic targets for lung repair prior to transplantation. Materials and Methods. A retrospective transcriptomics analyses were performed with peripheral tissue biopsies from "donation after brain death" lungs, with 46 pre/post-transplant pairs and 49 pre/post-EVLP pairs. Pathway analysi.
European Respiratory Journal 02/14/2020 06:10
Background. Chronic lung disease of prematurity (CLD), also called bronchopulmonary dysplasia, is a major consequence of preterm birth but the role of the microbiome in its development remains unclear. We, therefore, assessed the progression of the bacterial community in ventilated preterm infants over time in the upper and lower airways, and assessed the gut-lung axis by comparing the upper and lower airways bacterial communities with the stool findings. Finally, we assessed if the bacterial communities were associated with lung inflammation to suggest dysbiosis. Methods. We serially sampled multiple anatomical sites including the upper airway (nasopharyngeal aspirates, NPA), lower airways (tracheal aspirate fluid, TAF, and bronchoalveolar l.

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